Microbial Keratitis in Ocular Surface Disease

Although microbial keratitis is a known complication in eyes with chronic ocular surface disease, literature on this subject is scarce. The primary objective of this review is to describe the various aspects of microbial keratitis in ocular surface disease, with an emphasis on a better understanding of risk factors, causative organisms, antimicrobial therapy, and prevention.

The literature was reviewed in detail using multiple keywords and articles describing microbial keratitis in eyes with limbal stem cell deficiency, Stevens-Johnson syndrome, mucous membrane pemphigoid, keratoconjunctivitis sicca, meibomian gland dysfunction, post-chemical injury, and other common ocular surface pathologies.

Common risk factors identified include dry eyes, use of topical corticosteroids, soft contact lens wear, and eye lash abnormalities such as trichiasis and distichiasis. Gram-positive bacteria have been reported to be the most common causative agents. Sensitivity to Vancomycin was the highest among the gram-positive isolates. Non- healing or persistent epithelial defects or slowly healing epithelial defects were the most common complications in these eyes, warranting amniotic membrane grafting for faster epithelial healing.

Patients must be kept under regular monitoring, and indiscriminate use of topical antibiotics and corticosteroids must be avoided. Adequate patient education must be provided to enable patients to recognize warning signs early and seek immediate medical attention.